Category Archives: Law

New book hits hard at fundamentals of 12-step based sobriety support

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.

How much does a ‘label’ matter in getting help?

Dr. John Kelly

By “label,” I’m talking about what we, what society, and what the treatment industry calls someone who has an alcohol or drugs problem.

Often, that label is “substance abuser,” a labeling that Harvard’s Dr. John Kelly, an associate professor of psychology, said can be harmful indeed.

He says that label adds to stigmatization of people with an addiction, not just in society in general but among people at the Ph.D. level of study in psychology or related disciplines, including people planning on entering addiction counseling and substance abuse treatment work.

At a White House meeting, Kelly specifically told the federal “drug abuse czar” that, from the top down, the country’s frontline people in dealing with addiction need to work on changing their labeling vocabulary.

First, ‘methadone maintenance'; now, ‘beer maintenance’?

Use of methadone to help keep heroin addicts off of smack has always had some degree of controversy.

But, given that the amount of heroin addicts is far less than the number of alcoholics, methadone maintenance is surely far less controversial, or scary, than beer maintenance for alcoholic drinkers, I would think. Nonetheless, just that thing is being tried in …. where else, one might say? … Amsterdam.

After more than a decade out of work because of a back injury and chronic alcoholism, Fred Schiphorst finally landed a job last year and is determined to keep it. He gets up at 5:30 a.m., walks his dog and then puts on a red tie, ready to clean litter from the streets of eastern Amsterdam. …

His workday begins unfailingly at 9 a.m. — with two cans of beer, a down payment on a salary paid mostly in alcohol. He gets two more cans at lunch and then another can or, if all goes smoothly, two to round off a productive day.

“Interesting,” to say the least. It’s a partnership between the Dutch government and a nonprofit group.

The program, started last year by the Rainbow Foundation, a private but mostly government-funded organization that helps the homeless, drug addicts and alcoholics get back on their feet, is so popular that there is a long waiting list of chronic alcoholics eager to join the beer-fueled cleaning teams.

Oh, I’m sure it’s popular. It also perpetuates an old stereotype, which likely adds to the problem, rather than helping solve it:

One of the project’s most enthusiastic supporters is Fatima Elatik, district mayor of eastern Amsterdam. As a practicing Muslim who wears a head scarf, Ms. Elatik personally disapproves of alcohol but says she believes that alcoholics “cannot be just ostracized” and told to shape up. It is better, she said, to give them something to do and restrict their drinking to a limited amount of beer with no hard alcohol.

But, alcohol is alcohol, whether in beer, wine or spirits.

The second page of the story gets at the heart of the city’s stance, with this quote:

Read more ...

Choice in Recovery — Two Articles From Opposite Directions; Similar Conclusions

We often think of AA as being monolithic, speaking in one voice. In fact, AA has members who deviate sharply from the “established” principles. There are “Agnostic” AA groups which try to shed the religious element from the program. Since “religious elements” are central to much of AA’s approach, this is a difficult task, to say the least. A group and website called “AA Agnostica” defines itself as “a space for Agnostics, Atheists and Free Thinkers Worldwide.” A recent article posted on that website tackles the problem of the U.S. court system declaring any number of times that AA is religious and therefore cannot be mandated by a branch of the government due to the First Amendment. The article contends that the Twelve Traditions, which are much less explicitly religious than the Twelve Steps, should be placed at the heart of AA in place of the Twelve Steps. Some would argue that even the Traditions contain religious elements, including references to “a loving God.” Still, the article is an interesting read, not least because it explicitly accepts the Court’s view of AA as being legally a religiously-based organization. See the article Here

One person who never has had any problem seeing AA as religious is LifeRing’s founding leader Martin Nicolaus. He recently had an article published in Counselor: The Magazine for Addiction Professionals. That article, which can be viewed Here, gives details about a court ruling, a decision in the case of Hazle vs. Crofoot, which provides the most recent reinforcement of an earlier case (2009) that clearly required government at all levels to offer choice in recovery rather than mandating Twelve Step programs exclusively.

Both articles make for very interesting reading.

— Craig Whalley

 

Court Mandated Referrals to Support Groups Highlighted in Two Articles

courtHere are a couple of links to articles dealing with “choice in recovery” and court-mandated attendance at support meetings. One deals with a LifeRing member’s effort to ensure that people referred to treatment by the courts and other public agencies in Sonoma County, California, are told of all recovery support groups available on an equal basis. LifeRing itself has not been involved in such efforts, but we watch them closely and many of our members are strong supporters of the principle that those mandated to support meetings should have a clear say in which organization they must attend. Read about the changes brought about by the persistence of one person by clicking Here .

And read a more general discussion of court-mandated referrals to AA in this article from the newly revived website The Fix.com, a site devoted to news and articles of interest to all involved in recovery.

— Craig Whalley