The Sober Truth (27 page)

of addicts as counselors, 142–144

addiction switches, 85, 93, 108

addiction treatment studies, 29–57.
See

also specific studies
; claims of 12-step

programs and, 34–36; Cochrane

Collaboration review, 36–40; compliance

effect, 32–33, 39, 40, 41–42; controlled

(randomized) (
See
controlled studies);

definition of success, 33–34; demographics

of, 49; designing perfect

study, 150–151, 158–160; determining

actual success rates, 1–2, 52–53, 73–74;

dropout rates and, 44–50; evidence-

based studies as mirage, 151–157;

failure of, 147–160; failure to study

psychology of addiction, 152–153;

human studies, special considerations in,

29–31; of identical twins, 89;

ineffectiveness of AA, 56–57; lack of,

147–151; longitudinal, 41, 42, 43–44,

151; observational (See observational

studies); problem of spontaneous

remission, 53–55; project MATCH,

55–56, 150; publication of, limited in

scope, 148, 157–158; question of spirituality,

124–125; role of motivation,

50–52; statistics ineffectual in, 157–158

addicts: as addiction counselors, 69–70,

142–144; character defects of, 141–142,

145; demeaning treatment of, 99–100,

137–138, 143–144; need for individual

evaluation of, 132–133

“adventure therapy,” 9, 59, 64

Alcoholic Foundation, 21, 22, 24

Alcoholics Anonymous (AA), 11–28.

See also
Wilson, William Griffith

(“Bill”); actual success rates, 1–2,

122; antipathy to medical profession,

22–23; “Big Book” of (See
Alcoholics

Anonymous
[Wilson]); challenges to

dogma of, 131; on character defects of

addicts, 141–142, 145; claimed success

rates, 23–24, 34, 36–40; condemnation

of drug therapy, 106, 109, 117;

conditioning to guilt feelings, 118–119;

as contrived culture, 120; as cult,

100–102, 103; cult of personality in,

118; demeaning treatment of addicts,

99–100, 137–138, 143–144; dropout

rates from, 44–50; exposure to, during

hospitalization, 111, 113, 116; failures

(case studies), 7–9; failure to diagnose

depression, 99–100, 105, 115–120, 121;

as fellowship, 123–124; foundational

beliefs of, 131–132; founding of, 19–20;

inflated claims made by, 3–4; intensive

involvement with, 48, 50, 52–53;

as monopoly in treatment industry,

2–4, 131, 155; myths perpetuated by

(See addiction myths); negative effects

of, 56–57; newcomers to, 105–108;

personal safety at risk in, 107–108;

psychology of successes, 122, 127–133;

recognition by medical establishment,

24–26; within rehabilitation centers,

58, 60–61; religion and (See religion);

role of group dynamics, 123–124; roots

of, 17–19; self-promotion by, 22–24;

sexually predatory behavior in, 108,

117–118, 130; as social network, 121,

122, 132, 139–140; spirituality as factor

in, 124–127; spreading influence of,

26–28; steps in, 4–6, 128–129; studies

of (See addiction treatment studies;

specific studies
); successes of, 122–133;

suicide by members, 102–103, 108–109,

110; unsound theories of treatment,

130, 132; views held by (See moralistic

views of AA)

Alcoholics Anonymous
(Wilson), 3, 4, 16,

21, 27; AMA critique of, 24; moralistic

approach of, 142; on salvation

through surrender, 135–136

“Alcoholics Anonymous” (Alexander),

22–24

alcoholism: as addiction, 81; as behavior,

34; “disease theory” of, 25, 26, 100, 112,

155, 159; as disproof of neurobiological

model, 87; early “cures” for, 12–13, 14;

emotional trauma and, 112–115; family

history of, 14–15; personal relationships

ruined by, 116; spontaneous

remission rate, 54; treatments prior

to AA, 11–14; vilification as moral

weakness, 13

“alcoholism gene,” 88

Alexander, Jack, 22–24

American Journal on Addictions
, 147,

149–150

American Medical Association (AMA),

11, 24

American Psychiatric Association, 64

American Public Health Association, 26

Anderson, Philip, 156

anger, reduction of, 126

apologies, 5–6

Austen Riggs Center, 77

automatic behavior, 88

Avorn, Jerry, 40

Battle Creek Sanitarium, 78

Bauer, W. W., 26

Bayes, Thomas, 153, 154

Bayesian theory, 154, 156

behavioral psychiatry, 155

“Belladonna Cure,” 18–19

Betty Ford Center, 58; AA-based treatment,

60–61; claims of, 76; costs of

treatment, 71; daily schedule, 65–66;

“enhancements” to treatment, 59, 64

“Big Book.”
See Alcoholics Anonymous

(Wilson)

biochemical depression, 83

biological (biochemical) theories of

addiction: behaviors of biochemical

origin, 156; as fallacy, 152, 155–156;

flawed studies of, 147–148; neurobiology, 85–88

Bonaduce, Danny, 76

Brandsma study, 34–35, 36, 42

Breaking Addiction
(Dodes), 94, 159

“Cadillac” rehabs.
See
rehabilitation

centers

case reports.
See also
individual experiences:

of failures of AA, 7–9; on

psychology of addiction, 90–91, 93;

value of, 157–158

causality, 44

Celebrity Rehab
(TV series), 56, 60, 76

Census Bureau, US, 52

Chemical Dependency Recovery Program, 46–47

Churchill, Winston, 128

Cochrane Collaboration, 1–2, 36–40

Cochrane Review
, 37

cognitive behavioral therapy (CBT),

158, 159

collective organizations, 57

compliance effect, in observational studies,

32–33, 39, 40, 41–42

Comprehensive Alcohol Abuse and Alcoholism

Prevention Treatment and

Rehabilitation Act of 1970, 27

compulsion model of addiction, 83–85,

89–90

compulsive behaviors: as displacement,

89–90; multiple, 15–16, 93

concordance.
See
correlation

confrontation as tactic, 70

control attribute of rehab centers, 63

control groups: in designing perfect

study, 159; in human studies, 29–30;

lacking in observational studies,

44, 47

controlled studies, 31; of AA and TSF,

34–36, 37; designing perfect study,

150–151, 158–160; high cost of, 36,

158–159; observational studies compared, 29–32

conversion experiences: as basis of AA,

19–20; Jung as proponent of, 18; of

Marty Mann, 24–25; of Wilson, 2,

17, 18–19; of Wilson’s grandfather,

14–15, 18

correlation(s): Bayes’ theorem applied

to, 154; in observational studies, 30–31,

38–39; in twin studies, 89

cost of controlled studies, 36, 158–159

cost of rehab programs, 9–10; effectiveness

of treatment and, 70–72; lowering

in ideal programs, 80; as scam,

114–115; set by insurance carriers,

62–63

“cures” for alcoholism, 12–13, 14

Dana-Farber Cancer Institute, 77

data: disaggregation of, 40; elided, 42–43,

72–74, 151

Dawson, Deborah, 33

decision making, psychological significance

of, 87–88, 90–91

demeaning treatment of addicts: in

AA, 99–100; all addicts as “drunks,”

137–138; insanity myth and, 144; peer-

group attitudes, 139–140; in 12-step

model, 143–144

demographics of studies, 49

denial myth, 144–145

depression: AA misdiagnosis of, 99–100,

105, 115–120, 121; causes of, 83

detoxification services, 63

“disease theory” of alcoholism, 25, 26,

100, 112, 155, 159

displacement(s): addiction as, 91–92, 127;

compulsions as, 89–90; direct action

contrasted, 92

Dr. Rogers’ Hydropathic Sanitarium and

Congenial Home, 78–79

Dowling, Fr. Edward, 16

dropouts: not included in outcome

reports, 72–74, 75; poor results for, 52;

program effectiveness and, 44–50

drugs: drug courts, 28; heroin addiction,

83–84, 86–87; prescription, AA condemnation

of, 106, 109, 117; tolerance

to, 81; withdrawal from, 82

“drunks,” all addicts treated as, 137–138

emergent behaviors, 156

Emrick study, 35

engagement with programs, 51

“equine-assisted therapy,” 9, 59, 64

“evidence-based” science: failure to

study psychology of addiction, 152–

153; problems with studies, 151–152;

researcher prejudice in, 153–154; worship of, 152

failure of treatment: by AA (See Alcoholics

Anonymous [AA]); addiction

counselors and, 69–70, 142–144;

addiction myths and (
See
addiction

myths); case stories of (
See
individual

experiences); clinical depression

undiagnosed, 99–100, 105, 115–120, 121;

coercion of patients, 97–98; confrontational

tactics, 70; consequences of,

7–9, 76–77; demeaning treatment

of addicts, 99–100, 137–138, 143–144;

dropouts, 44–50, 52, 72–74, 75; early

“cures” for alcoholism, 12–13, 14; guilt

feelings and, 99–100, 116, 118–119;

“hitting bottom” as excuse for, 135;

lack of individual treatment, 65–68,

137–138; moralistic excuses for, 5–6,

13, 98–99, 110; need for individual

evaluations, 132–133; for newcomers

to AA, 105–108; 90/90 prescription

and, 140–141; “one-size-fits-all” view

and, 137–138; problems with treatment

studies (See addiction treatment studies);

in rehabilitation centers, 9–10,

76–77; relapses, 137; suicides, 102–103,

108–109, 110; TSF as setup for failure,

103, 105–106, 114; unsound theories

and, 130, 132

federal government, 1, 13, 159

Fernside Center, 61

Fingarette, Herbert, 53

Fiorentine study, 43, 53; compliance effect

error in, 40; correlation in, 38–39;

multiple regression analysis used in,

39–40

Gamblers Anonymous, 56

Gelber, Richard, 45, 49

genetic loading, 88, 89

genetic theory of addiction, 88–89, 147,

155–156

Grapevine
, 26

group therapy: general attributes of,

123–124; ideal construction of, 79; in

rehab programs, 67–68

guilt feelings, 116; AA conditioning to,

118–119; self-demeaning statements,

99–100

Harris study, 52–53, 124–125

“hazardous” drinking, 49, 75–76

Hazelden Treatment Center, 9, 10;

costs of treatment, 71; daily schedule,

66–67; history of, 58; “Minnesota

Model” of treatment, 60; outcomes

reported by, 72, 74

The Heart of Addiction
(Dodes), 89,

90–91, 156

helplessness: addiction as reversal of,

91–92, 127; admission of, 4, 5; combating

feelings of, 7–9; direct response to,

94–95; in “disease theory” of alcoholism,

25; in psychology of addiction,

145; rage at, 92; surrender to “higher

power” and, 136

heroin addiction, 83–84, 86–87

higher brain functions, 87–88

“higher power,” 127–131; in AA steps,

128–129; consequences of identifying

with, 130–131; identification with powerful

figures, 127–128; illusory nature

of, 129–130; surrendering to, 135–136

“hitting bottom,” 134–135

Horvath, Arthur, 26–27

hospitalization: exposure to AA during,

111, 113, 116; inebriate hospitals, 13; as

part of “rehab,” 60–67

humility, 130

identical-twin studies of addiction, 89

impaired physician programs, 28

independent testing, 43

individual experiences, 96–121; AA as

cult, 100–102, 103; AA misdiagnosis of

depression, 99–100, 105, 115–120; alcoholism

and emotional trauma, 112–115;

demeaning treatment in AA, 99–100;

dissatisfaction with 12-step philosophy,

98–99; feelings of coercion, 97–98;

negativity of AA, 105–107; psychology

of addiction, 90–91, 93; rigidity of AA,

109–110; “13th-stepping,” 108, 117–118,

130; 12-step based rehab, 103–104;

warning signs for suicide, 102–103

individual therapy: in ideal rehab,

79; missing from rehab programs,

65–68; “one-size-fits-all” treatment

contrasted, 137–138; in psychiatric

centers, 68

inebriate hospitals, 13

“Inquiry into the Effects of Ardent Spirits

on the Human Mind and Body”

(Rush), 11–12

insanity myth, 144

insurance carriers, 62–63

intensive involvement with program, 48,

50, 52–53

Intervention
(TV series), 1, 60

Ioannidis, John, 153, 154, 155

James, William, 18

Jellinek, E. M., 25–26

Johnson, Lyndon B., 27

Journal of Addiction Medicine
, 148

Journal of Addictive Behaviors
, 72, 74–75

Journal of Consulting and Clinical Psychology
, 47

Journal of Drug and Alcohol Dependence
,

147

Journal of Inebriety
, 14