Lance Dodes has been treating people suffering with addictions for over thirty years. In his book The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry,
he takes to task Alcoholics Anonymous (AA) and other such programs as largely unhelpful avenues that serve only to increase an addict's sense of shame and helplessness. He points to passages in the Big Book,
the AA's "bible," with concern -- the 1939 book was written at a time we didn't well understand addiction, and at several junctures the book makes it clear that dealing with addiction is a question of restraint that requires strong moral fiber. "In other words," writes Dodes, "the program doesn't fail; you fail."
I am a recovering alcoholic. In my journey to sobriety, my first stop was Alcoholics Anonymous. I was in Peru at the time but in such a bad way that I couldn't call the local number and try to explain what I was feeling in Spanish, so I called their office in New York. I don't remember that conversation, but I recall feeling enormously grateful that I had reached someone at such an ungodly hour, someone who was ready to talk to me without the need for me to make an appointment or wait a few days to see them.
When it comes to access, AA has doctors beat. And it isn't just in terms of availability -- AA and other such programs don't require you to check with your insurance company or demand a high copay. They're free. They're everywhere. At my home group in Lima, a small English-speaking group that met once a day, we frequently received visits from professionals traveling on business to Peru. AA is accessible, it's free, and it's spread so widely around the world that it enables people a level of flexibility they don't have unless their psychologists are willing to Skype for sessions. A lot of them aren't.
Like most recovery groups, we discussed the 12 steps on occasion, but though we used a church to meet, the emphasis was never placed on God. The only step that came up time and again and everyone seemed to be perpetually working on, was Step Four ("Made a searching and fearless moral inventory of ourselves"), which invariably played into Step Eight ("Made a list of all persons we had harmed and became willing to make amends to them all") and Step Nine ("Made direct amends to such people wherever possible, except when to do so would injure them or others"). This focus set the tone -- recovery is a great task composed of a number of things, each different for every person, but in order to get at it, we need a safe place from which to begin.
As social animals, there is immense value in a group of people who are not only going through what you're going through, but who are available to give structure to your life. When I quit drinking, I had no idea who
I was. I didn't know how to have fun. Fun had meant going out to a bar or a club for so long, I didn't know what to do with myself when I wasn't working. In Lima, where nightlife is everything, I had no idea where to go. It didn't help that many friends I spoke with told me I was overreacting about the "drinking problem" and to go ahead and relax with a nice glass of wine. AA offered me a space where I could speak about my worries and a network of people to do things with. It's not that they offered me "distractions." They showed me life, love and fun were possible without setting foot in a bar, in a club or in a bottle.
I am not saying addiction is a social problem, that I was drinking because my friends were drinking. I was drinking largely to self-medicate -- something that would require psychology to untangle -- but it was essential for me to begin the journey to understanding that from a safe place where life was possible.
AA gave me social support in a way that no therapist ever has. This is precisely why Step Four, Eight and Nine are important -- they serve to repair bonds that have been debilitated or broken by addiction and enable people in your life to form part of your support system once again. This isn't just another version of doing penance for sins, as Dode claims -- it's useful. Granted, some people are not going to forgive you. Those steps are hard for a number of reasons, rejection chief among them -- but when you start from a group, you have a social safety net.
Dode is right that these things often don't address the addiction itself, however, and that in many cases they can exacerbate it. I was fortunate to have found the group I did on my first try. I didn't realize groups could differ so widely from one place to another. AA might be everywhere, but it's not one size fits all. The U.S. seemed a whole different animal in terms of recovery than Peru, where in my small group, I had related to everyone who passed through -- we were very similar socioeconomically, in level of education, in terms of expectations, and other life concerns. In California, I felt like a poser sharing my "rock bottom" story. During a break, someone told me I was lucky to have caught my disease "early" before it caused "real" damage in my life. I moved from meeting to meeting feeling more and more like an impostor. I never again spoke about how sobriety had left me with a fractured identity. Who cares about a little prat who wants to "find" herself when people are losing homes, custody of their children, facing jail time? I don't blame them.
The result of being unable to relate to a group was a lack of ready-made safety net. Fortunately, by that point, I had been in the program for a while and knew that there was life beyond the bottle. I was even going to bars and clubs again, and ordering a coffee was as natural as ordering a vodka martini had once been. It helped me that I was in a new place -- the friends I had made since arriving knew me as someone who didn't drink alcohol. When they invited me out, they always made sure the places they suggested served coffee, just as they made sure it served vegan tapas or craft beer. In time, the functions I had depended on the program to provide me were taken over by my new, sturdy social group.
I had a safe space, so I could continue investigating the causes of my addiction. This made it easy to leave the program -- in the U.S., the groups I had visited seemed to have a heavy focus on religion. Though I was very interested in Judeo-Christian religion, my interest was and is a lot more academic than people in the program were willing to entertain. The religious function of the program was hope, which is fine -- but I wanted more than hope. I wanted serious study and informed discussion. I can easily see how religious emphasis would make it incredibly inaccessible for an atheist, non-Christian, or someone suffering a crisis of faith to relate to people in the program. This sort of difference is often glossed over, but it's real -- and it prevents a person from relating and seeking solace within a group. It denies them the safe space from which they can begin.
Another issue that made it easy for me to leave was the tallying. I never liked counting the days I'd been sober -- the notion that we should treat recovery a day at a time was essential for me. Counting days seemed like a violation of that. Worse, I felt that if I started counting, I would get careless. I could see myself rationalizing, "I've been sober this long, I can have this one glass of wine." For me to stay out of the bottle, it was and remains of the utmost importance to believe that just one sip will kill me.
Early on, I had printed out a photo of David Lynch's offering to the Cow Parade, a gruesome fiberglass sculpture of a cow, beheaded and mutilated to show its internal organs with the words "Eat My Fear" carved on its side (http://goo.gl/9AYgwT
). It was rejected by the Cow Parade project but it found a home with me. I have no idea how I found it, but when I did, I had it framed as one would a family photo, and it lived by my bed and later by my desk, as a constant reminder that my concern about the "alcohol problem" was a real one. I called this contemplation "eating my fear" and I did not count how often I did it. I just did it.
I don't have that photo anymore, but whenever I feel an urge to drink -- or self-medicate in some other way -- I look it up on my phone. It's not that the cow can cure addiction. It's that the cow reminds me of what I'm doing. It's unlike any other image in my house and life and it brings me back to the decision I made one night in Lima that no matter what's going on, the answer is not going to be found belly up in a dirty Barranco street with a head injury, too drunk to remember how I got there.
AA and programs like it have a gamification component to them. Counting sober days enables people in recovery to get the meatspace equivalent of a badge, which we call "chips." No one ever forced me to take a chip or celebrate my "birthday," what the program calls the last day you quit, in my first group. This was different in the United States, where tallying was a big part of a meeting and chips were awarded to people with great fanfare. Back in Lima, this part happened quietly right at the end of the meeting, with most people crowded around the coffee already socializing while others went to the front of the room to get their chips. I understand the usefulness of gamification, but even then I wondered whether this was actually helpful. What do you do with the chips when you relapse? Does your sponsor come and take them away? I never asked. I wanted nothing to do with them.
When I started watching Dexter
and saw the protagonist's girlfriend force him into the program, using the chips to monitor his attendance, I realized how easily chips could become a tool of control. And here is where I most agree with Dode about his assessment of many recovery programs: for the most part, they enable us as a society to pretend that we have addiction handled. Addicts can be funneled into these programs, which costs us next to nothing, their progress can be tracked through chips, and we can, as a society, wash our hands of the whole thing.
It's a lot like telling victims of sexual assault to go away and take up their issues with law enforcement. We know the rate of failure of the program is high, just as we know that conviction rates for sexual assault are low, but we can ignore by shifting the blame. We tell assault victims that theirs is a fuzzy case, they shouldn't have done this thing or that thing -- they're not perfect victims. We tell people who fail the program that they aren't "working" it. That they aren't ready. That they're not "turning themselves over." That they didn't "bottom" hard enough. After all, it works if you work it!
It's not the system that's flawed. It's the person who's flawed.
This is a problem. The most unfortunate part is that this path is not chosen but frequently mandated -- by a court or school or some other institution. But these mandates don't offer addicts help -- no one tells you that you might benefit from shopping around for a group where you fit in. No accommodations are made to help address the addiction beyond the social component.
The problem with these programs is that they make us think that we have a handle on the problem when we don't. Recovery is something that requires a lot of different factors to come together for a person. AA only addresses the social aspect -- assuming you find the right group in the first place. The safe place it can provide is a good start, but that's not the end of the path.
In his article, Dode mentions psychoanalysis as a solution. I feel like I need to add caution to that example. While I was looking for a group to call my own in the United States, I was also looking for a mental health professional to help me work through things I had identified -- while in the program -- as possibly being related to my drinking. But just as AA groups vary, so, too, do mental health professionals. I will never forget going through a few as a teenager (each of which wanted to put me on scarier and weirder drug cocktails) after my parents found bondage gear in my closet. I refused to be medicated and "solved" and researched every therapy they suggested to lobby for a second and then a third opinion before committing to anything. Finally the last -- who had the sort of accent you would expect from Freud -- explained to me (and later them) that there was nothing wrong with me, provided I understood consent and only pursued my "interests" with people who did, too.
Though anecdotal, stories from gay friends to gender-nonconforming friends to religious friends to sex worker friends indicate that it's of the utmost importance to do your research before you get on the couch with a therapist. You need to know where this person stands on issues that are crucial to your identity and your life and that at the very least they don't perceive them as a defect or paraphilia. To this end, local organizations might have a list of providers whom they deem "friendly." It's worth getting in touch with them and asking. Before you get to your appointment, you should probably ask what school of thought they follow, to get an idea of how they may try to get at those root causes, and a sense of how they will treat them. It took one supremely weird adventure in Gestalt therapy to really drive that point home for me, but there it is. This stuff is more important than whether they take your insurance. Sadly, cost makes access to a suitable mental health option horrifically inaccessible. Don't give up.
There is no single solution to addiction. But the avenues we have are worth exploring -- if only to understand their components so we can improve on them. This is why Dode's work is important, though it will no doubt anger a lot of people who have benefited from the program. I think the key takeaway is this: "Any substantive conversation about treatment in this country must reckon with the toll levied when a culture encourages one approach to the exclusion of all others, especially when that culture limits the treatment options for suffering people, ignores advances in understanding addiction, and excludes and even shames the great majority of people who fail in the sanctioned approach."